3. INTRODUCTION OF MOLLUSCUM CONGTAGIOSUM
• Molluscum contagiosum (MC) is a viral infection of the skin and mucosal tissues
characterized by skin-colored or transparent round nodules with a dimple or pit
in the center.
• The virus is transmitted by skin contact or sexual intercourse.
• The infection is caused by a DNA poxvirus called the MC virus. Although MC
generally occurs in children.
• The lesions disappear spontaneously within several months
in most cases.
4. EYELID MOLLUSCUM CONTAGIOSUM
• Molluscum contagiosum (MC) is characterized by papular lesions in the skin and
mucous membranes caused by the Molluscum contagiosum virus, a DNA virus
from the poxvirus group.
• Humans are the only known host.
• It is particularly common in hot, developing countries and in communities with
poor personal hygiene.
• It can also be seen in immunosuppressed patients (e.g. with AIDS or using drugs
such as corticosteroids, TNF-α antibodies, and methotrexate), and in patients with
atopic dermatitis.
5. SIGNS & SYMPTOMS
• The lesions, located on the skin and mucosa, typically appear as small (between
about 2-6 mm), raised, flesh-colored or clear papules and there is pearly white
caseous material in the pitted center.
• The papular lesions, usually found in clusters, are often seen on the face, head,
torso, and extremities in children.
• And in the genital area, lower abdomen, and upper legs in young adults in whom
the infection is sexually transmitted.
6. • Ophthalmic MC lesions are often located on the eyelids.
• Viral proteins shed from the lid lesions into the tear film can lead to a
hypersensitivity reaction with secondary chronic follicular reaction, punctate
keratopathy in the conjunctiva.
• Rarely, primary MC lesions are seen in the conjunctiva and cornea.
• The lesions usually resolve spontaneously within a few months, treatments such
as excision, incision and curettage, cryotherapy, cauterization.
• Topical chemical agents, and oral cimetidine can be used in refractory cases and to
speed up the healing process.
8. CASE STUDY- 1
• A 5-year-old female patient who had raised lesions on her right eyelid for
about 3 months and complaints of redness and watering in her right eye
was admitted to a clinic. It was learned that she had previously been seen
by three different ophthalmologists and had been treated with topical
ofloxacin (Exocin® 4 times daily), olopatadine HCl (Patanol® 2 times daily),
and dexamethasone sodium phosphate (Dexa-sine® 3 times daily) for 2
months. Visual acuity measured with E chart was 20/20 in both eyes.
Intraocular pressure (IOP) was 12 mmHg in both eyes.
9. Figure 1A
Image of patient showing 2 pitted papular lesions situated 2 mm from the lash
line of the right upper lid and a similar lesion 5 mm from the lash line on the
lateral aspect of the lid
10. Figure 1B
Image of patient showing conjunctival hyperemia and intense follicular reaction
at the lower fornix
11. Suspecting MC, the existing treatment was discontinued and topical
ganciclovir (Virgan® gel 3 times daily), lubricant treatment (Tears Naturale
Free® drops 5 times daily), and eyelash cleansing were recommended.
Complete blood count and immunoglobulin levels were normal.
The family was informed that the lesions may spontaneously regress, and
would be surgically excised if they did not. We observed in follow-up
examination 1 month later that the lesions and symptoms had not regressed,
so the papular lesions were excised preserving the integrity of the cyst wall
and cryotherapy was applied to the base of the lesions.
13. The patient was treated postoperatively with topical moxifloxacin (Vigamox®) drops 5 times
daily for 2 weeks and lubricant eye drops (Tears Naturale Free® 5 times daily). At 1-month
follow-up, the lid lesions had disappeared and the follicular reaction was reduced.
Figure 1E & 1F
Postoperative images of patient show the eyelid lesion has disappeared and the follicular
reaction in the conjunctiva has completely regressed
14. • A 24-year-old female patient presented to our clinic with complaints of swelling of
the right upper eyelid and redness in the eye for 2 months. Her visual acuity was
20/20 in both eyes and IOP was 14 mmHg.
15. Figure 2B
Image of patient showing a pitted papular lesion 2x2 mm in size situated 4 mm from the
lash line on the medial aspect of the right upper eyelid
16. Figure 2B
Image of patient showing conjunctival hyperemia and mild to moderate follicular
reaction in the tarsal conjunctiva
17. Treatment after Identifying
• Serological tests for HIV and hepatitis A, B, and C viruses were negative.
Immunoglobulin levels and lymphocyte subtype values were within normal limits.
• To reduce the viral load in the patient’s eye, a half-strength dilution of betadine (5%)
was instilled and washed out after 30 seconds. Treatment was initiated with topical
moxifloxacin (Vigamox® drops 3 times daily), topical ganciclovir (Virgan® gel twice
daily), and lubricant therapy (Tears Naturale Free® drops 5 times daily).
• Follow-up examination 3 weeks later showed that the lesion and ocular symptoms had
not regressed, so the larger papule was excised preserving the integrity of the cyst wall
and cryotherapy was applied to the base of the lesion. Cryotherapy was applied directly
to the smaller papule.
18. Figure 2C
Eosinophilic inclusion bodies are observed in the cytoplasm of squamous cells in the
stratum granulosum layer (hematoxylin&eosin, x100)
19. Figure 2D & 2E
Postoperative images of patient show the lesion on the eyelid has disappeared and the
follicular reaction in the conjunctiva is decreased
